EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1475139
SEPTEMBER 2022 | EYEWORLD | 53 Contact Name: email R Relevant disclosures Hatch: Carl Zeiss Meditec, CXLO, Glaukos, Johnson & Johnson Vision Parkhurst: STAAR Surgical on which of those four different lengths the surgeon chose to use." When monitoring vault at all visits, Dr. Parkhurst said to document it in an objective way to see if there are changes over time. If the vault was large from day 1, for example, and the IOP went up suddenly at week 1, the angle closed, the most likely diagnosis would be pupillary block and an angle closure IOP event, potentially necessitating an ICL exchange. If the vault was low/normal in the early postop period and suddenly increased later leading to angle closure, the more likely cause is obstruction of flow through the iridotomy, not the size. The newer design of the EVO Visian ICL (STAAR Surgical) with a central fenestration eliminates this latter scenario, Dr. Parkhurst said. Endothelial monitoring for phakic IOLs, Dr. Parkhurst said, was necessary with anterior chamber phakic IOLs. Dr. Parkhurst said a bene- fit of posterior chamber phakic IOLs is that they are not in close proximity to the endothelium. "In my opinion, there is not a big utility of monitoring the endothelium with these posteri- or chamber lenses because chronic endothelial cell loss has not been shown," he said. Dr. Hatch said she will routinely check the endothelial cell count at the time of the preop workup for a phakic IOL candidate, to get a baseline. Postop, she said she will monitor it. "It would be an unusual situation to have to explant the lens, but certainly if you see the cell count going down and there is a high vault and a situation where there is concern, you might consider explanting it," she said, adding later that anterior segment OCT might be valuable in the postop period to assess implant vault. Dr. Hatch offered these main takeaways for all post-refractive surgery patients regardless of the procedure: 1) do topography at all follow- up visits and 2) advise patients to not rub their eyes at all follow-up visits.